Wednesday, February 27, 2008

Medical experts, advocacy groups and Veterans Affairs Department officials say VA’s disability rating schedule needs to be updated — continually — but they denied the system is so bad that it needs to be dumped completely.

A Tuesday hearing of the House Veterans’ Affairs subcommittee on disability assistance and memorial affairs also focused on studies conducted over the past year that point toward needed improvements not only in the ratings schedule, but in VA’s disability retirement system itself.

Rep. John Hall, D-N.Y., chairman of the subcommittee, said VA needs to remove “archaic” criteria from the rating schedule; update psychiatric criteria to better reflect symptoms of troops diagnosed with post-traumatic stress disorder; find out why so many veterans with PTSD have been rated fully disabled; and update neurological criteria to include new research on traumatic brain injuries.

“The VA needs the right tools to do the right thing,” Hall said.

VA argued that it is already doing the right thing and has been updating the rating schedule, though officials acknowledged they could do better. From 1990 through 2007, VA had updated 47 percent of the ratings schedule, but 35 percent of the codes had not been touched since 1945. However, VA said it updated the codes for TBI in January and is working on an update for PTSD.

In educational interest, article(s) quoted from extensively.

Continuing:

The Veterans’ Disability Benefits Commission began looking at how service members’ and veterans’ disability cases were being handled long before February 2007, when Military Times and the Washington Post featured stories highlighting problems in the system. Retired Vice Adm. Dennis McGinn, a member of the commission, said VA has made “very limited progress” since the group’s report came out in October.

“I believe the ratings schedule needs to be clarified so it has logic from the point of view of medicine and science,” McGinn said. “It has not progressed in the last five decades.”

The group found that VA compensates veterans according to the schedule in a way that is “generally adequate to offset average impairment” and that the schedule does “reasonably well.”

But there are specific areas where VA’s system does not serve troops and veterans well, McGinn said, including those with PTSD, those severely disabled at a young age and those granted maximum benefits because a disability makes them unemployable.

Veterans with PTSD, he noted, have “much greater loss of employment and earnings” than those with physical disabilities.

McGinn recommended separate criteria on the rating schedule for PTSD, as well as a way to compensate unemployable veterans for lost quality of life, not just their inability to work.

So-called “individual unemployability” veterans may have formal VA disability ratings of less than 100 percent, but are still rated fully disabled because of their inability to work. The commission found that almost half of the 223,000 IU veterans have primary diagnoses of PTSD or other mental disorders.

The problem is that if a veteran has physical disabilities that lead to a 100 percent disability rating, he can still work and keep his full compensation. But a veteran who has a 100 percent disability for a mental disorder tries to work, he loses his compensation.

This could inspire a veteran to avoid seeking out vocational rehabilitation or employment, and also implies something “suspect” about claiming PTSD — which only adds to the considerable stigma behind the disease, said Dean Kilpatrick, a member of the Committee on Veterans’ Compensation for Posttraumatic Stress Disorder at the Institute of Medicine.

McGinn also requested couples therapy as part of treatment for PTSD. That is important because responding to a veteran’s anger with more anger can exacerbate the problem, while learning how to work with a spouse suffering PTSD can be part of a cure, he said. Also, many family members deal with their own mental health issues while living with someone with PTSD.

McGinn’s group and Kilpatrick had different recommendations as far as follow-up evaluations for people with PTSD. Again, other disabilities are not re-examined, so an exam puts those with mental disabilities in a separate class. But McGinn’s group sees follow-ups as a way to encourage vets to seek further treatment.

Kilpatrick said the exam for PTSD is also key. Examiners need to be carefully trained in how to diagnose and rate PTSD, and the exam should take up to three hours, rather than the 20 minutes that the Institute of Medicine found is often the case with veterans.

Sidney Weissman, a member of the American Psychiatric Association, said it is critical for for VA to repeat and update the training so that the way veterans are rated is standardized — rather than veterans in Ohio, for example, receiving higher ratings for the same symptoms than veterans in Texas.

Brad Mayes, director of VA’s Compensation and Pension Service, said VA has a five-part plan for updating the schedule: A study to look into the matter, hiring and training staff, finishing revisions that are under way, creating a review process, and looking at the possibility of quality-of-life compensation.

“I think you’re right on point, and we agree,” Mayes told Hall. “There has to be an ongoing, systemic approach.”

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Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

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"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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